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Wanted: More Instructors and More Nurses

If you wind up in the hospital today, you’ll see plenty of nurses. Looks are deceiving in this instance.

“Because of the recession, some people are becoming complacent that there is not a nursing shortage,” said Brenda L. Cleary, a registered nurse and director of the Center to Champion Nursing in America, a collaboration of AARP, the AARP Foundation and the Robert Wood Johnson Foundation. “It’s a temporary thing.”

The recession has temporarily eased the looming nursing shortage as older RNs who expected to hang up their uniforms instead are hanging on until their retirement accounts recover. Others who left or reduced their work hours to raise children came back for full-time salaries and benefits.

“As the economy recovers, nurses who had to delay retirement will retire; nurses who wanted to stay home with their kids are going to,” said Mary Lou Brunell, executive director of the Orlando-based Florida Center for Nursing. Their exodus could refuel the nursing crisis.

America’s medical institutions already operate in the shadow of a worst-case scenario that projects a shortage of nurses as high as 1 million by 2020, when the boomers will be well into their gray years.

The advancing age of instructors with master’s and doctoral degrees—average age 53.5—threatens to hamper nursing schools’ ability to train enough nurses. Schools also struggle to find enough clinical settings for hands-on practice.

Health care reform could add millions of newly insured Americans to the medical system, which is already highly dependent on nurses. More faculty will be needed to produce new graduates to fill roles as nurse specialists, such as midwives or anesthetists.

One clue to nursing schools’ inability to keep up can be found in the rising numbers of rejected applications from qualified candidates. Last year, four-year nursing programs turned away 41,385 qualified applications, up from 3,600 in 2002, according to the American Association of Colleges of Nursing. (Because there’s no way to track how many aspiring nurses applied to multiple programs, application figures don’t reveal actual numbers of applicants accepted or rejected.)

Nursing schools cannot accommodate all applicants for two principal reasons. “One is faculty shortage, the other clinical space capacity,” said Brunell. Nursing programs cannot arrange enough faculty-supervised training time at hospitals and clinics for all their prospective nursing students.

"The root of the faculty shortage is an inadequate supply of RNs with graduate degrees prepared for faculty roles, but the salary issue doesn’t provide much incentive,” Cleary said. Starting nursing salaries are good enough that many registered nurses aren’t driven to continue their schooling. For those who do, salaries for practicing nurses with advanced degrees can be $25,000 to $30,000 a year higher than academic salaries.

“In some cases, newly graduated nursing students may make more than their faculty teaching them,” said Deloras Jones, executive director for the California Institute for Nursing & Health Care in Berkeley.

States are trying to nurture new nurses. In 2005, California launched a five-year, $90 million initiative that pumped private and public money into nursing education. In August, the state approved a five-year, $60 million extension—even as other programs fell to budget cuts. The money supports incentives such as loan forgiveness for nursing students who pledge to teach after earning advanced degrees.

One way to assess how states are coping is by studying the number of working RNs for every 100,000 residents. In 2008, the national average was 836 per 100,000 population, according to the Kaiser Family Foundation.

  • The five states with the fewest RNs were Arizona, 581; New Mexico, 600; Nevada, 613; Utah, 630; and California, 654.
  • The five with the most RNs were South Dakota, 1,245; Massachusetts, 1,226; Rhode Island, 1,081; Minnesota, 1,068; and Maine, 1,067.

To see how your state measures up, click on state, the Kaiser Family Foundation site that lists state-by-state numbers of RNs per 100,000 residents.

Health reform proposals moving through the House and Senate include money to offset the cost of higher education for nurses and to train more advanced practice registered nurses to serve a growing Medicare population. And the federal stimulus bill dedicated between $100 million and $150 million to train nurses and nursing educators, according to Winifred V. Quinn, senior legislative representative for AARP.

By leveraging federal, state and local funding, a small community college in California’s agricultural heartland has added a half-dozen tenure-track teachers to its faculty and more than tripled the number of nursing students.

“We at little old College of the Sequoias in the Central Valley … have made huge contributions to easing the nursing shortage,” said Cindy DeLain, dean of nursing. Her school has minimized its dropout rate, while about 90 percent of the recent nursing graduates passed licensing exams. DeLain recalled that in 1996, when she began to teach at the college, there were 105 students in the nursing program; this fall, there are 330.

Despite those successes, DeLain fears the recession that has left 2008 and 2009 graduates without jobs may deter others from nursing “and we could be in a worse situation.”

Jane E. Allen is a Los Angeles-based freelance journalist who specializes in health and medicine.